Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve

Khalid, Shehzad; Iwanaga, Joe; Loukas, Marios; Tubbs, R. Shane

doi:10.7759/cureus.1555

Cited by 9 publications

(12 citation statements)

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“…Anatomical variants of the iliopsoas muscle have been described [2345]. Clarkson and Rainy [2] reported a rare case with four psoas muscles: the psoas major and minor and psoas tertius and quartus.…”

Section: Discussionmentioning

confidence: 99%

“…Tubbs et al [5] reported a variant of the psoas quartus where it arose from the transverse process of the third lumbar vertebra and the anteromedial aspect of the quadratus lumborum. Recently, Khalid et al [4] reported a case of the psoas tertius piercing the FN. An “accessory psoas major muscle” [3] that is fusiform shaped and arose from the third lumbar and intertransverse ligament between the third and fourth lumbar vertebrae has been described.…”

Section: Discussionmentioning

confidence: 99%

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A multiply split femoral nerve and psoas quartus muscle

et al. 2019

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The femoral nerve is the largest branch of the lumbar plexus. It is normally composed of the ventral rami of spinal nerves L2 to L4. The psoas major has proximal attachments onto the T12 to L5 vertebrae and related intervertebral discs, fuses with the iliacus deep to the inguinal ligament and then attaches onto the lesser trochanter of the femur. Normally, the anatomical relationship is that the femoral nerve is located between the iliacus and psoas major. Herein, we report a case of the psoas quartus muscle related to several splits of the femoral nerve within the pelvis. Although the embryology for this is unclear, surgeons and physicians should be aware of such anatomical variants in order to better understand pain and entrapment syndromes and during surgical maneuvers in this region such as lateral transpsoas approaches to the lumbar spine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A multiply split femoral nerve and psoas quartus muscle

et al. 2019

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“…Por lo tanto, el reconocimiento de esas variaciones anatómicas puede ser de utilidad para el clínico cuando trate a un paciente con dolor del miembro inferior con sintomatología recurrente. En algunos informes se han notificado variaciones anatómicas en los músculos psoas e ilíaco, asociados a una división (split) del NF causando un posible riesgo de atrapamiento de éste (Khalid et al, 2017).…”

Section: Introductionunclassified

Split Unilateral del Nervio Femoral a Nivel del Músculo Psoas Mayor: Reporte de Caso

2021

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RESUMEN:El nervio femoral (NF) es el mayor o ramo del plexo lumbar. Normalmente se origina de las divisiones posteriores del segundo al cuarto ramo anterior del plexo lumbar (L2-L4). El músculo psoas mayor tiene su origen a nivel de las vértebras T12 a L5, se fusiona con el músculo ilíaco para luego insertarse en el trocánter menor del fémur. Normalmente, a nivel de la pelvis menor el NF se encuentra entre los músculos ilíaco y psoas mayor. En este trabajo presentamos un caso donde el músculo psoas mayor se relaciona con divisiones o split del NF, esta es una rara variación en la división y curso del NF con relación al músculo psoas mayor. Se observó que el NF se dividía en dos ramos por sobre el plano del ligamento inguinal después de su origen en el plexo lumbar. El NF del lado izquierdo se formó por las ramas ventrales de L2 a L4, a nivel de L5 el nervio es perforado por fascículos del músculo psoas mayor. La división inferior del NF pasaba profundamente a las fibras del músculo iliopsoas y la división superior pasaba superficialmente al músculo psoas mayor y profundo a la fascia ilíaca. Después de un trayecto de 60,21 mm ambas divisiones se unieron, después de atrapar fibras músculo iliopsoas justo inmediatamente proximal al ligamento inguinal para formar el tronco del NF. Si bien las causas embriológicas de las variaciones de los nervios periféricos se remontan a la quinta y sexta semana de vida intrauterina, la expresión clínica de disfunciones neuromusculares aparecerá varios decenios después. De modo que los médicos de las áreas de la traumatología y neurología deben estar al tanto de tales variantes anatómicas para entender mejor el dolor y los síndromes asociados a la compresión nerviosa y durante las maniobras quirúrgicas en esta región.

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“…The psoas muscle group is part of the posterior abdominal wall and is comprised of long muscles – major, minor, and tertius [ 1 ]. Out of those, only the psoas major muscle is an obligatory muscle present in all individuals [ 2 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

Psoas Minor Muscle: A Cadaveric Morphometric Study

Dragieva

Zaharieva

Kozhuharov

et al. 2018

Cureus

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IntroductionThe psoas muscle group is part of the posterior abdominal wall and is comprised of long muscles – major, minor, and tertius. Out of those, only the psoas major muscle is an obligatory muscle present in all individuals. The psoas minor muscle (PMM) originates as vertical fascicles inserted in the bodies of the last thoracic and first lumbar vertebrae and inserting into the iliopectineal eminence. The muscle provide flexion of the lumbar spine in a limited fashion. The aim of the study was to establish the frequency of the muscle in the Bulgarian population.Materials and methodsThis study was carried out in the Department of Anatomy and Cell Biology, Medical University, Varna, Bulgaria, by Dr. Paraskev Stoyanov in November 2017, on a total of 10 cadavers. The length, width, and circumference of the muscles were measured. The collected data were interpreted in a descriptive manner.ResultsThe PMM was present in six out of ten cadavers (60%). Out of those six cadavers, the muscle was bilateral in three, unilateral on the left side in one, and unilateral on the right side in two cadavers. The average length of the muscle was 19.66 cm (range:14.4 cm - 21.7 cm), average width was 1.73 cm (range: 1.0 cm - 3.2 cm ) and average circumference was 3.48 cm (range: 1.7 cm - maximum 5.6 cm). The male to female ratio of cadavers with a PMM was 1:1.ConclusionThe frequency of the muscle's variations considering its presence in the Bulgarian population (60%) is higher when compared to its presence in the Indian population (36.67%), virtually identical to the Brazilian population (59%), and lower than that reported in the US (65.6%). The morphometric analyses of the different populations showed a shorter psoas minor in the Bulgarian population.

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Split Femoral Nerve Due to Psoas Tertius Muscle: A Review with Other Cases of Variant Muscles Traversing the Femoral Nerve

Cited by 9 publications

References 8 publications

A multiply split femoral nerve and psoas quartus muscle

A multiply split femoral nerve and psoas quartus muscle

Split Unilateral del Nervio Femoral a Nivel del Músculo Psoas Mayor: Reporte de Caso

Psoas Minor Muscle: A Cadaveric Morphometric Study

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